Management of COPD in End-of-Life Care by Spanish Pulmonologists

Ecenarro, Patricia Sobradillo; Iguiñiz, Marta Inchausti; Tejada, Sandra Pedrero; Malanda, Nuria Marina; Imizcoz, María Alfonso; Marlasca, Laura Ansola; Alcázar, Bernardino

doi:10.1080/15412555.2018.1441274

Cited by 21 publications

(16 citation statements)

References 25 publications

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“…A recent survey in Spain has revealed several deficiencies in the management of these cases and their support to the family [92]. Specifically, another neglected aspect of advanced COPD care is in relation with the evaluation of the social aspects of the disease, preventing the system to provide a comprehensive and efficient care if not considered [93].…”

Section: Will We Be Able To Solve the Asthma-copd Overlap Dilemma?mentioning

confidence: 99%

Ten Research Questions for Improving COPD Care in the Next Decade

Lόpez-Campos

Rodríguez

Quintana‐Gallego

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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With the 60th anniversary of the CIBA symposium, it is worth evaluating research questions that should be prioritized in the future. Coming research initiatives can be summarized in main areas. 1. From epidemiology the impact of new forms of electronic cigarettes on prevalence and mortality of COPD will be sought. 2. The study of the disease endotypes and its relationship phenotypes will have to be unraveled in the next decade. 3. Diagnosis of COPD faces several challenges opening the possibility of a change in the definition of the disease itself. 4. Patients' classification and risk stratification will need to be clarified and reassessed. 5. The asthma-COPD overlap dilemma will have to be clarified and define whether both conditions represent one only chronic airway disease again. 6. Integrating comorbidities in COPD care will be key in a progressively ageing population to improve clinical care in a chronic care model. 7. Non-pharmacological management have areas for research including pulmonary rehabilitation and vaccines. 8. Improving physical activity should focus research because of the clear prognostic impact. 9. Pharmacological therapies present several challenges including efficacy and safety issues with current medications and the development of biological therapy. 10. The definition, identification, categorization and specific therapy of exacerbations will also be an area of research development.During the next decade we have a window of opportunity to address these research questions that will put us on the path for precision medicine.

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Section: Will We Be Able To Solve the Asthma-copd Overlap Dilemma?mentioning

confidence: 99%

Ten Research Questions for Improving COPD Care in the Next Decade

Lόpez-Campos

Rodríguez

Quintana‐Gallego

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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“…In addition, guidance about who is responsible for initiating ACP is often lacking, and a lack of established protocols for who is responsible for initiating ACP has been identified as another barrier to implementing COPD into routine COPD management. 16,17,26 For patients, the key is having a well-informed health-care professional who is familiar with them and their history to carry out ACP discussions at an appropriate time. 3,27 For some, this may be a general practitioner, but, for others, it may be a hospital-based treating clinician.…”

Section: Discussionmentioning

confidence: 99%

“…A lack of training for health-care professionals has been identified as a barrier to implementing ACP into routine management. 16,17 To ensure that the topics of future educational interventions are relevant and meaningful to the target audience, the objective of this study was to identify gaps in health-care professionals' knowledge re-…”

Section: Introductionmentioning

confidence: 99%

An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

et al. 2019

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BACKGROUND: Individuals with COPD typically experience a gradual deterioration in health, with exacerbations and increased health-care utilization in the years before death. As such, adequate planning of future care is necessary. The objective of this research was to identify gaps in health-care professionals' knowledge related to advance care planning (ACP) for patients with COPD and to prioritize content of future educational interventions for health-care professionals accordingly. METHODS: A modified e-Delphi technique with 2 rounds of rating was used. After a literature review and expert consultation, a multidisciplinary panel developed 40 statements. Statements that did not achieve consensus in round 1 were represented in round 2, together with new statements developed after participant feedback. Health-care professionals with expertise in caring for people with COPD were asked to rate the importance of including each of the 40 topics in future educational interventions related to ACP and COPD by using a 5-point Likert scale. Average scores for each topic were calculated and expressed as percentages. Consensus on each topic was achieved if it obtained a score of >80%. RESULTS: Thirty-eight health-care professionals were invited to participate, of whom, 21 (55%) took part in both rounds. Consensus was achieved for 32 of 40 statements (80%) in round 1 and for 5 of 10 statements (50%) in round 2. All statements relating to "COPD and palliative care" and "legislation for ACP" achieved consensus after one round. CONCLUSIONS: This study uncovered specific topics that related to ACP and COPD that healthcare professionals believe should be included in future educational interventions. In particular, there is a clear need for training that addresses the legal issues surrounding ACP, and information on the best timing and content of ACP discussions with patients with COPD. Such training may enable health-care professionals to incorporate ACP into routine COPD management and, ultimately, improve patient care.

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“…53 Despite this, there remain few effective treatments for chronic breathlessness, making it a major challenge in improving palliative and end-of-life care. 18,[54][55][56][57] There are limited pharmacological treatments for chronic breathlessness 43,58 and there are currently no licensed medicines for the treatment of this symptom anywhere in the world. 2,59-62 Systematic reviews of effectiveness and clinical trials are available for opioids, oxygen and benzodiazepines.…”

Section: Current Treatment and Service Provisionmentioning

confidence: 99%

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

Maddocks

Brighton

Farquhar

et al. 2019

Health Serv Deliv Res

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Background Breathlessness is a common and distressing symptom of many advanced diseases, affecting around 2 million people in the UK. Breathlessness increases with disease progression and often becomes chronic or refractory. Breathlessness-triggered services that integrate holistic assessment and specialist palliative care input as part of a multiprofessional approach have been developed for this group, offering tailored interventions to support self-management and reduce distress. Objectives The aim was to synthesise evidence on holistic breathlessness services for people with advanced disease and chronic or refractory breathlessness. The objectives were to describe the structure, organisation and delivery of services, determine clinical effectiveness, cost-effectiveness and acceptability, identify predictors of treatment response, and elicit stakeholders’ evidence-based priorities for clinical practice, policy and research. Design The mixed-methods evidence synthesis comprised three components: (1) a systematic review to determine the clinical effectiveness, cost-effectiveness and acceptability of holistic breathlessness services; (2) a secondary analysis of pooled individual data from three trials to determine predictors of clinical response; and (3) a transparent expert consultation (TEC), comprising a stakeholder workshop and an online consensus survey, to identify stakeholders’ priorities. Results Thirty-seven papers reporting on 18 holistic breathlessness services were included in the systematic review. Most studies enrolled people with thoracic cancer, were delivered over 4–6 weeks, and included breathing training, relaxation techniques and psychological support. Meta-analysis demonstrated significant reductions in the Numeric Rating Scale (NRS) distress due to breathlessness, significant reductions in the Hospital Anxiety and Depressions Scale (HADS) depression scores, and non-significant reductions in the Chronic Respiratory Disease Questionnaire (CRQ) mastery and HADS anxiety, favouring the intervention. Recipients valued education, self-management interventions, and expertise of the staff in breathlessness and person-centred care. Evidence for cost-effectiveness was limited and inconclusive. The responder analysis (n = 259) revealed baseline CRQ mastery and NRS distress to be strong predictors of the response to breathlessness services assessed by these same measures, and no significant influence from baseline breathlessness intensity, patient diagnosis, lung function, health status, anxiety or depression. The TEC elicited 34 priorities from stakeholders. Seven priorities received high agreement and consensus, reflecting stakeholders’ (n = 74) views that services should be person-centred and multiprofessional, share their breathlessness management skills with others, and recognise the roles and support needs of informal carers. Limitations The evidence synthesis draws predominantly from UK services and may not be generalisable to other settings. Some meta-analyses were restricted by reporting biases and statistical heterogeneity. Conclusions Despite heterogeneity in composition and delivery, holistic breathlessness services are highly valued by recipients and can lead to significant improvements in the distress caused by breathlessness and depression. Outcomes of improved mastery and reduced distress caused by breathlessness are not influenced by patient diagnosis, lung function or health status. Stakeholders highlighted the need for improved access to person-centred, multiprofessional breathlessness services and support for informal carers. Future work Our research suggests that key therapeutic components of holistic breathlessness services be considered in clinical practice and models of delivery and educational strategies to address stakeholders’ priorities tested. Study registration This study is registered as PROSPERO CRD42017057508. Funding The National Institute for Health Research (NIHR) Health Services and Delivery programme. Matthew Maddocks, Wei Gao and Irene J Higginson are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London; Matthew Maddocks is supported by a NIHR Career Development Fellowship (CDF-2017-009), William D-C Man is supported by the NIHR CLAHRC Northwest London and Irene J Higginson holds a NIHR Emeritus Senior Investigator Award.

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Management of COPD in End-of-Life Care by Spanish Pulmonologists

Cited by 21 publications

References 25 publications

Ten Research Questions for Improving COPD Care in the Next Decade

Ten Research Questions for Improving COPD Care in the Next Decade

An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

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